A large-scale cohort study in South Korea has found a statistically significant association between metabolic dysfunction–associated steatotic liver disease and an increased risk of sudden sensorineural hearing loss among older adults.
Using data from the Korean National Health Insurance Service–Senior Cohort, investigators followed 189,623 individuals aged 65 years and older for 9 years. Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, was defined by a fatty liver index of 30 or higher and the presence of one or more cardiometabolic risk factors (e.g., type 2 diabetes, obesity, hypertension).
Of the study population, 105,398 individuals met criteria for MASLD. During the follow-up period, 3803 SSNHL events occurred in the MASLD group, corresponding to an incidence rate of 2.44 per 1000 person-years, compared with 2.31 per 1000 person-years in the non-MASLD group.
After adjusting for potential confounders including age, sex, income, physical activity, smoking status, and comorbidities, MASLD remained significantly associated with sudden sensorineural hearing loss (SSNHL). The adjusted subdistribution hazard ratio (SHR), accounting for competing mortality risk, was 1.06 (95% CI, 1.01–1.11).
This association persisted in sensitivity analyses that excluded SSNHL cases occurring within the first 1 to 3 years of follow-up, suggesting a cumulative impact over time.
As the authors noted, “Given the observed association, it is important that MASLD may be a modifiable risk factor for SSNHL.” They added that routine auditory screenings in elderly patients with MASLD may enable earlier detection and intervention.
Subgroup analyses indicated higher risk among individuals with MASLD who also had hypertension, type 2 diabetes, or dyslipidemia. Older adults, women, and those not engaging in moderate to vigorous physical activity also showed increased susceptibility. Although past and current smokers with MASLD had higher SHRs than nonsmokers, these findings were not statistically significant.
Participants with MASLD had significantly higher mean body mass index, waist circumference, blood pressure, fasting glucose, and liver enzyme levels. The authors suggest these metabolic and inflammatory abnormalities may contribute to cochlear damage through impaired circulation, oxidative stress, and systemic inflammation.
The association was specific to SSNHL; no significant link between MASLD and Ménière’s disease was identified.
While the study used validated noninvasive biomarkers to define MASLD, the lack of imaging or audiometric data limits diagnostic precision. Nonetheless, the authors propose that MASLD may represent a modifiable risk factor for SSNHL, and that hearing screenings in this population could facilitate earlier detection and intervention.
The authors declared no conflicts of interest.